Provider Demographics
NPI:1417016023
Name:ACROLYST PHYSICIAN RESOURCES
Entity Type:Organization
Organization Name:ACROLYST PHYSICIAN RESOURCES
Other - Org Name:MEDICAL ASSOCIATES OF KINGS MTN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADIX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-739-7887
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086
Mailing Address - Country:US
Mailing Address - Phone:704-739-7880
Mailing Address - Fax:704-739-7887
Practice Address - Street 1:827 E KING STREET
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086
Practice Address - Country:US
Practice Address - Phone:704-739-7880
Practice Address - Fax:704-739-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty